Ch 89 Rheumatoid Arthritis Flashcards
What is rheumatoid arthritis
A CHRONIC, progressive inflammatory disease that can affect tissues and organs but, principally affects the joints producing an inflammatory synovitis. It involves joints bilaterally and symmetrically, & it typically involves several joints at one time. RA typically affects upper joints first.
What is RA precipitated by
It is an auto immune disease precipitated by WBCs attacking synovial tissue. The WBCs cause the synovial tissue to become inflamed and thickened. The inflammation can extend to the cartilage, bone, tendons, and ligaments that surround the joint. Joint deformity and bone erosion may result, decreasing the joints ROM and function.
What does the phrase RA is also a systemic disease mean
It can affect any connective tissue in the body. Common structures that are affected are the blood vessels, pleura surrounding the lungs, and pericardium. Iritis and scleritis can also develop on the eyes…
The natural course of the disease a exacerbations and remissions
What are risk factors of rheumatoid arthritis
Female gender Age 20-50 years Genetic predisposition Epstein Barr virus Stress Enviromental factors
What are early signs of rheumatoid arthritis
Fatigue
Joint discomfort
What is subjective signs of RA
Pain at rest and with movement
Am stiffness
Pleuritic pain ( pain upon inspiration)
Xerostomia ( dry mouth) Subcutaneous nodules
Anorexia/ weight loss Low grade fever
Fatigue Muscle weakness/ atrophy
Paraesthesias Reddened sclera and abnormal pupil shape
Recent illness/ stress Lymph node enlargement
Joint pain/ lack of function
What is objective assessment data of RA
Joint swelling, warmth and erythema
Ulnar deviation, swan neck, and boutonnière deformities are common in the fingers
What joints are generally affected by RA
Finger, hands, wrists, knees, foot joints
What are lab tests to diagnose RA
- Anti- CCP will be positive ( this test detects antibodies to cyclic citrullinated peptide…. The test will test + long before symptoms appear…. Very sensitive test to RA
- RF antibody. High tigers correlate with severe disease
- ESR
- C reactive protein
- ANA titer
- Elevated WBC
What is the erythrocyte sedimentation rate
Elevation is associated with inflammation or infection in the body
20-40 indicates mild inflammation
40-70 indicates moderate inflammation
70-150 indicates severe inflammation
* other autoimmune diseases can increase ESR
What is ANA
Anti nuclear antibody
antibody produced against ones own DNA
What are diagnostic procedures for RA
Arthrocentesis ( synovial fluid aspiration by needle, with RA, increased WBC and RF are present in fluid
What is recommended teaching for morning stiffness related to RA
Hot shower
What is recommended teaching for edema
Cold therapy
What are medications for RA
Treatment begins with NSAIDS which provides analgesic, antipyretic, and anti inflammatory effects…NSAIDS can cause considerable GI distress.